Pneumonia with recent or concurrent influenza


Staph aureus is a more common respiratory pathogen in CAP or HAP if concurrent or recent influenza infection.

Amoxicillin doesn’t have activity against Staph aureus. Co-amoxiclav does have good activity

  • Clinical deterioration of mild-moderate CAP (i.e. CURB 1 or 2) despite empirical antibiotics – consider adding IV flucloxacillin 1g QDS (or IV vancomycin as per guidance if history of MRSA)

  •  Severe CAP (i.e. ≥CURB 3) – follow CAP (severe) - CURB 65 3-5 guideline as recommended antibiotics will have good Staph aureus activity (consider adding vancomycin as per guidance if history of MRSA)


Post-influenza HAP  - follow HAP guidelines (consider adding IV vancomycin if clinical deterioration despite empirical antibiotics or if history of MRSA)


Risk of invasive pulmonary aspergillosis post-influenza infection - send sputum samples requesting fungal culture if suspected (e.g. persisting dyspnoea, fever, haemoptysis, suspected on imaging)